I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist. My focus tends to be mind-body oriented psychotherapy. See my profile for more info. This site is not intended as a substitute for psychotherapy. No client-counselor relationship exists between the user and the owner of this site. To set up a consultation with me please call (212) 726-1006. All material on this site is copyrighted and cannot be used without permission.

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Saturday, January 3, 2015

In an earlier article, Self Blame and the Internal Critic, I began a discussion about how people often experience self blame. In this article, I will discuss self blame, the need to feel in control and how experiential therapy, like EMDR, helps to achieve emotional breakthroughs.

Self blame can come in many forms, including a general feeling of "I'm wrong" or "I can't do anything right."

Self blame can also relate to a specific misfortune or trauma in one's life, including loss.

For people who are stuck and mired in self blame related to a traumatic incident, the feelings of self blame often give them the sense that they could have controlled some aspect of the traumatic event when it occurred and that this would have brought about a different outcome.

In most cases, this is an illusion and keeps people stuck emotionally at the point where the trauma incident occurred.

The following scenario is a composite of many different cases to protect confidentiality:Rena
Rena came to therapy because she blamed herself for the death of her husband, who died on 9/11 at the World Trade Center.

Several years had passed since the tragic event and every day Rena thought about how she could have prevented her husband from dying that day if only she had insisted that he stay home from work because he wasn't feeling well.

She replayed the last moments in her mind over and over again--when she saw her husband as he was standing in their bedroom trying to decide whether to go to work or stay home.

He was sneezing and coughing, and she thought about telling him to stay home but, for some reason which she could never figure out, she didn't say it. Instead, she told him to come home early if he felt worse and, with that, he kissed her, walked out the door, and she never saw him again.

Rena had attended cognitive behavioral therapy (CBT) a few months after her husband died and, because of that therapy, she realized that she wasn't really to blame. But her realization was very much on an intellectual level and it didn't help to dispel the grief and guilt that she felt.

Deep down on an emotional level, she still felt that if only she had insisted that her husband stay home, he would be alive today. Even though she knew logically that this made no sense, on an emotional level, she carried this heavy burden.

The weight of her grief and guilt was such that all she could do was go to work, come home and sleep. She no longer saw her friends or engaged in activities that she used to enjoy.

Since Rena's prior therapy only helped her in a limited way, she wanted to try a different type of therapy.

So, when her friend told her that she was able to resolve a personal trauma with Eye Movement Desensitization and Reprocessing therapy (EMDR), Rena read up on EMDR and decided that she wanted to try this experiential form of mind-body oriented therapy (see my article: What is EMDR?).

Rena wanted to work on the memory that she replayed in her mind over and over since 9/11.

After getting Rena's personal history and helping Rena to develop coping skills to work on the trauma, which took several sessions, we began to process the trauma.

The Connection Between Self Blame and the Illusion of Control

When I asked Rena to think about an image that represented the worst part of that memory, she told me that in her mind's eye, she saw her husband standing in their bedroom as he was weighing whether or not to go to work and she was standing nearby, concerned, but silent.

Just saying these words caused Rena a great deal of pain and she sobbed. After a few moments, she stopped crying and she was able to identify where in her body she felt the grief and guilt--in her chest and throat.

Identifying feelings in the body is an important difference between experiential therapies (like EMDR) and CBT, which tends to stay on the cognitive level.

Then, in keeping with the EMDR process, I asked her what words would best describe how she feels about herself now with regard to that memory, and she said, "I should have made him stay home so he would be alive now."

In terms of how disturbing this memory was for her on a scale of 0-10 (where 0 equals no disturbance and 10 equals the most painful disturbance imaginable), Rena said it felt like a 10.

Then, I asked Rena what words best describe how she would like to feel about herself in relation to that memory, and she said she wanted to feel, "I did the best that I could."

At that point in EMDR therapy, Rena didn't feel this way about herself at all.

Before we started processing this traumatic memory, I reminded Rena that if at any time she felt she was too upset to continue, she could signal me and we could stop for a few minutes or stop altogether for the rest of the session. It was important for her to know that she was in charge.

Although Rena experienced waves of sorrow during the EMDR processing, she did not want to stop because she felt that something was shifting inside of her, but she wasn't sure what it was yet.

This sense of internal shifting is a common experience for clients who are in EMDR therapy.

We continued to work on this memory for several more weeks.

At the end of each session, we talked about the session, and Rena continued to say that she felt something, which was unidentifiable to her, that was shifting internally. At that point, it was still hard for her to imagine that she could ever let go of her guilt and sadness for not stopping her husband from going to work on 9/11.

Then, a few weeks later, Rena had an emotional breakthrough.

Until then, as I mentioned earlier, her understanding that her husband's death was not her fault was only a logical construct in her mind--she didn't feel it emotionally, and she continued to carry this contradiction within herself.

But on that day, as she sensed into her body to feel what emotions came up for her about the memory, she realized that she wasn't feeling self blame. She was sad that her husband died, but she didn't feel responsible for his death.

At first, she could hardly believe that there had been this internal shift within her.

Instead of feeling self blame, she felt a deep sense of knowing that she couldn't have altered the chain of events. She felt deeply that she wasn't to blame. She knew deep down that no matter what she would have said, based on how her husband reacted in similar situations prior to that day, he still would have gone to work. So, she couldn't have controlled the situation--and now she knew this on a an emotional level.

Afterwards, when we talked about this, Rena said that her sense of knowing that she wasn't to blame was different this time from how she had felt before. She said that this time she felt it in her gut and in her heart.

She knew on a deep level that the idea that she could have changed the course of events was an illusion that she had been hanging onto.

As we continued to work together, what surfaced was that Rena's illusion that she could have changed the course of events at that pivotal point (when he was standing in the bedroom trying to decide what to do) served to keep her feeling emotionally attached to her husband--to that last time that she saw him.

This is why, prior to her emotional breakthrough, thinking about that moment over and over again was so powerful for her.

This emotional breakthrough for Rena helped her to release her grief, which had been pent up in her for several years. It also allowed her to deal with other emotions that had been covered over by her feelings of self blame.

Over time, we continued to work on other emotional issues that arose about her husband's death, including her feelings of abandonment. Even though she knew logically that her husband didn't choose to leave her, she experienced this common reaction that people often have when loved ones die.

Along the way, Rena learned other ways to have an internal experience of closeness for her husband without having to remain stuck in the traumatic memory.

Being able to feel the release of grief helped her to start putting her life back together again. Gradually, she began to see friends again and she took up hobbies that she had neglected since her husband's death.

CBT as a Counteractive Therapy vs EMDR as Experiential Therapy
Each client is different and there's usually no way to know in advance what will be emotionally transformative for a particular client.

I do use CBT for some clients under some circumstances, but my experience as a psychotherapist who specializes in working with trauma, has been that, although CBT can be useful to a certain extent, it often offers limited help, particularly in situations described in the scenario about "Rena."

Of course, it's important for clients to understand on a cognitive level that they're not to blame for traumatic incidents that they could not have controlled. But, as in the case with Rena, this kind of cognitive understanding is limited and clients will often say, "I know logically that I wasn't to blame, but I still feel on an emotional level that it was my fault."

It's important that clients understand that feeling this contradiction isn't at all unusual when it comes to trauma.

The problem with CBT in these instances is that it is a top-down approach that acts only as a counteractive force to the negative feelings that clients feel about themselves, which often keeps the internal conflict of what they know vs. what they feel in place for clients.

It provides the client with an alternative to how they're thinking, which is good, but it often doesn't change the feelings where they reside, which is deep in the limbic part of the brain.

Experiential therapies, which use a bottom-up approach that involves the mind-body connection, like EMDR, Somatic Experiencing, clinical hypnosis and other types of experiential therapies, go to that deeper level and help to make the emotional shift that leads to emotional breakthroughs.

Skilled EMDR therapists also know how to work in a way where clients feel emotionally safe, which is important for clients who have experienced trauma.

I'll discuss this topic further in a future article.

Getting Help
Many people live their whole lives blaming themselves for traumatic events that they could not have changed. They live with the illusion that they could have controlled events, and this serves to keep them stuck in the memory.

If this resonates with you, you owe it to yourself to get help from a licensed mental health professional who has expertise in one of the experiential types of therapy, like EMDR, Somatic Experiencing and clinical hypnosis, among others.

Once you're no longer living as if you're still in that traumatic memory, you will be free to live a fulfilling life.

About MeI am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.To set up a consultation, call me at (212) 726-1006 or email me.